Should Rescue Breathing Be Made Redundant?

In 2008, the American Heart Association released new recommendations that bystanders who feel uncomfortable with performing mouth-to-mouth CPR instead perform a form of “hands-only” CPR that does not include the rescue breathing component. Subsequent studies have shown that hands-only CPR is as effective for patients as the mouth-to-mouth version. But in some ways, CPR without rescue breathing might be better news for healthcare in general than mouth-to-mouth CPR. Here’s a look at the issues.

How CPR works

CPR is a method of circulating oxygenated blood throughout a patient’s circulatory system in the absence of a functioning heart, while the victim waits for emergency rescue personnel to arrive and administer more intensive treatment. In the traditional form of CPR, a rescuer breathes into the victim’s mouth, pushing oxygenated air into the victim’s lungs—and then presses down on the victim’s chest to circulate the blood throughout the body.

With hands-only CPR, you don’t perform the rescue breaths. Instead, you perform rapid, uninterrupted chest compressions. This has been shown to be generally as effective as traditional CPR—and, in some cases, more effective.

The problem with mouth-to-mouth CPR.

Mouth-to-mouth CPR requires the rescuer to have contact with the mouth of the victim. This can be worrying to many bystanders who may have concerns about catching communicable diseases—or passing them along to the victim. Some bystanders have difficulty overcoming the “ick” factor to deliver care in the timeframe needed.

This is a problem for victims of cardiac arrest. That’s because many cardiac arrests occur outside of a hospital or medical facility—in the home, on the street, in the workplace, and in other areas where professional medical care may be more than seconds away. It takes from four to six minutes for brain death to set in after a cardiac arrest, and a victim’s chance of survival drops by 7-10% for each minute he or she does not receive CPR. The average response time to an emergency call is approximately 10 minutes, although that can vary dramatically depending on where you live.

What this means for most victims is that if you have a cardiac arrest, you will most likely need CPR well before emergency responders arrive. A bystander trained in CPR may be your only hope of receiving lifesaving care in time.

This is why the American Heart Association pushes so hard for people outside of the medical care industry to get certified in CPR—the more trained bystanders there are, the more people who experience cardiac arrest outside of a hospital will be likely to get the immediate care they need. Bystanders have to be ready and willing to perform CPR.

In addition, hands-only CPR is easier to remember than traditional CPR. Instead of having to remember the number of breaths and the number of compressions you need, you only have to perform rapid compressions. It makes CPR easier to perform—and more likely that bystanders will feel confident enough to perform it.

Why hands-only CPR may work better in some instances.

There are definitely instances where mouth-to-mouth CPR is more effective than hands-only CPR. This includes times when the victim is an infant or child; or someone suffering from breathing problems or drowning. However, hands-only CPR is generally better than none at all, even in these instances.

In addition, for those who are not accustomed to providing CPR on a regular basis, hands-only CPR may be more effective than traditional CPR. That’s because, for an untrained bystander acting alone, it can be difficult to keep the compressions consistent without pause during rescue breathing. The interruption in compressions can lessen the effectiveness of the treatment. With hands-only CPR, you can get a rhythm going and don’t have to stop for rescue breaths, which can be beneficial to patients.

In all, rescue breathing is still an important part of traditional CPR—but hands-on CPR is just as effective in most cases, and can be more effective in that untrained bystanders are noticeably more willing to perform it. It’s also easier, meaning it may be more effective for bystanders to perform. It’s definitely better than no CPR at all—and hopefully hands-on CPR will make it possible for more victims to get the lifesaving care they need, when they need it.

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About the author

Dr. Mary Williams, RN, DC

Dr. Mary Williams, R.N., D.C is a Doctor of Chiropractic with an extensive background as a Registered Nurse and experienced Core Instructor for the American Heart Association. She has over 30 years of hands-on medical and instructional experience.